Medical Data Entry

Sonia McGee

Credentialing Specialist

Oak Lawn, IL 60453

************@*****.*** - 312-***-****

Private

Desired Job Type:Full-time

Work Experience

Credentialing Specialist

Elmhurst Memorial Hospital - Elmhurst, IL

October 2014 to August 2015

I also worked there from August 2013 to February 2014.

Processed approximately 250 New staff appointment applications/reapplication for physicians and allied health professionals. Responsible for coordinating all aspects of the credentialing and primary

source verification process for practitioners/allied health professional and health delivery

organizations according to policy and procedures. Performed credentialing and re-credentialing processes according to JACHO, URAC, NCQA standards. Processed initial and re-credentialing applications from all providers. Completed data entry of applications using MSOW software, reviewing them for errors prior to turning in the provider files for quality review. Worked in Excel spreadsheet to input summary reports. Organized credential files, verified training, peers, insurance claims history and hospital affiliations. Faxed all documents to be verified and completed on providers. Forwarded completed files to the Credentials Committee and Vice President of Medical Staff for review.

Credentialing Specialist

DuPage Medical Group - Downers Grove, IL

April 2014 to October 2014

Responsibilities

Credentialing Specialist/Medicare processing of applications.

Accomplishments

Completed physician enrollment form into Medicare.

Credentialing Specialist

Norwegian American Hospital - Chicago, IL

October 2012 to December 2012

Assisted with processing 250-300 Medical/Allied Health professional staff reappointment applications. Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners/allied health professional and health delivery organizations according to policy and procedures. Performed credentialing and re-credentialing processes according to JACHO, URAC, NCQA standards. Processed initial and re-credentialing applications from providers. Completed data entry of applications, reviewing them for errors prior to turning in the provider files for quality review. Ensured insurance claim verifications and NPDB matched with corrected forms submission and corrections. Scanning, editing, faxing and copying documents. Prepared and send out re-credentialing groups.Complete 1st, 2nd and 3rd request for re-credentialing packets. Ongoing monitoring/watch follow-up specialist. Completed follow up for provider files and 'watch' status. Ensured that follow up occurs for ongoing state license action monitoring reports. Ensured that follow up occurs for the ongoing Medicare/Medicaid sanctions monitoring reports. Delegation specialist: maintained the minimum volume of delegated provider entered into system (MSOW) to ensure expected levels of productivity. Entered data into system (MSOW) of delegate information should be done with required timeframes. Updated delegate information received from delegate groups be completed with required timeframes.

Credentialing Specialist

Advocate Healthcare Corporation - Oak Brook, IL

November 2000 to October 2011

Processed all initial applications for Medical/Allied Health Professional Staff appointments and clinical privileges to meet policies and procedures. Medical Staff Bylaws, Joint Commission on Accreditation of Healthcare Organizations (JCAHO).Completed data entry of applications, reviewing them for errors prior to turning in the provider files for quality review. Responsible for all the provider credentialing documentation. Prepared redentialing documents to meet PHO, JACHO and NCQA standards. Processed new physician/allied health professional applications and recredentialing applications using electronic paperless entry and MSOW software. Completed follow up for provider files and 'watch' status requirements. Ensured that follow up occurred for the ongoing state license action monitoring reports. Ensured that follow up occurred for the ongoing Medicare/Medicaid sanctions monitoring reports. Updated delegate information received from delegate groups should becompleted with required timeframes. Maintained CVO certifications by NCQA. Gathered and reviewed critical data to determine applicant's eligibility for credentialing and

re-credentialing purposes. Audited various credentialing files for accuracy for contracted payers. Run standard reports for missing and expired information. Provided

administrative support services to Medical Staff Office and its management support group to meet the hospital's legal, accreditation, and regulatory requirements under the direction of the Manager of department and customer satisfaction. Facilitated the flow of information with the organizational structure of the medical staff office and the CVO. Collaborated with Quality Assurance, Care Management and Health Information Services, creating physician profiles for use during reappointment proceedings. Coordinator and monitor effective information systems for the credentials verification office, medical staff office including dissemination of public and confidential information, as appropriate. Coordinated all special projects as requested.

Education

AA in Business and Word Processing

Kennedy King College - Chicago, IL

1977 to 1979

Skills

Excellent Credentialing Specialist skills and MSOW software

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